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Orthopedic
Case Study
74-year-old female admitted to Oxford Rehabilitation and Healthcare Center from Jefferson Torresdale Hospital, where she initially presented after a fall. Work-up revealed left hip fracture. Patient s/p intramedullary nail. Post-op WBAT and receiving Lovenox for DVT PPX. Past medical history significant for PAD, left BKA,HTN, cardiomyopathy, Afib and CHF. Patient was transferred to Oxford Rehab for continued medical optimization and ongoing therapy services.
Nursing Interventions:
Medication Management – Lovenox, Amlodipine, Carvedilol, Hydralazine, Amiodarone, Keppra, Plavix, Lasix
Close Monitoring of Vital Signs – including weights and pulse ox
Close Monitoring of Labs – CBC and BMP
Ensure Adequate Nutrition – consistent carb diet with Ensure Plus daily
Cardiologist Interventions:
Followed closely by our Cardiologist, Dr. Frank Ammaturo for her cardiac history. While in-house her medication regimen was optimized and she remained stable from a cardiac perspective.
Therapy Interventions:
Upon admission, she required Max A for bed mobility, sit-stand transfers, and sliding board transfers. She also required assistance with self-care including Mod A for bathing, toileting, and lower body dressing. She made significant gains to regain her independence. At discharge, she advanced to standby assistance for bed mobility and transfers. With contact guard assistance,
she was able to ambulate 60 feet with platform walker and left below the knee prosthesis. She also made advancements with her activities of daily living including Min A for bathing, lower body dressing and toileting. She was also able to advance to standby assistance for upper body bathing, contact guard assistance for lower body dressing and Mod I for upper body dressing.
After a successful stay at Oxford Rehab, the patient discharged home with support from St. Mary Home Health. She will continue to follow with her PCP, Dr. Horacio Hidalgo in the community.
Heart Failure / Cardiac
Case Study
62-year-old male admitted to Oxford Rehabilitation and Healthcare Center from Jefferson Torresdale Hospital, where he initially presented with shortness of breath, AMS and productive cough. Patient found to have acute on chronic respiratory failure s/p intubation and subsequent extubation to nasal cannula. Work-up further revealed new onset of congestive heart failure – EF 20-25% and CAD s/p stent and LifeVest placement. Past medical history significant for HTN, GERD, possible COPD and prior ICH after MVA. Patient transferred to Oxford Rehab for continued medical optimization and ongoing therapy services.
Nursing Interventions:
Close Monitoring of Vital Signs including weight and pulse ox
Ensure Adequate Nutrition – tolerating heart healthy diet with 1500 ml fluid restriction
LifeVest Management – checked q shift and battery changed daily. Continued education to the patient on the importance of the device and how to manage the device in the community.
Cardiology Interventions:
Patient was followed by our Cardiologist, Dr. Frank Ammaturo. Patient with cardiomyopathy – continue Farxiga, Lasix, and Metoprolol, continue LifeVest – will be considered for ICD as outpatient. Coronary artery disease s/p recent LAD stent – continue Aspirin and Brilinta.
Respiratory Interventions:
Patient was followed closely by our in-house Respiratory Therapist. Upon admission, he required 2L oxygen via nasal cannula. Prior to discharge, he was successfully weaned to room air.
Therapy Interventions:
An individualized therapy plan was developed consisting of physical and occupational therapy. At discharge, he advanced to Mod I for bed mobility and transfers. With supervision, he was able to ambulate community distances with no assistive device and safely ascended/descend 12 steps. He also regained his independence with self-care and was independent with bathing, dressing and toileting.
After 14-days at Oxford Rehab, the patient was discharged home with support from family and St. Mary Home Care. He will continue to be followed by his PCP, Courtney Harrigan, CNRP and Cardiologist, Dr. Srinivas Atri in the community.
Heart Failure
Case Study
81-year-old female admitted to Oxford Rehabilitation and Healthcare Center from St. Mary Medical Center, where she initially presented with shortness of breath. Patient found to have acute congestive heart failure with preserved ejection fraction in the setting of chronic diastolic dysfunction and atrial fibrillation. Cardiology consulted. Patient s/p IV Lasix with improvement in her dyspnea. She was also started on Farxiga. For Afib, patient appears to be rate controlled and started on Eliquis. Past medical history significant for diabetes, COPD, CKD stage III, HTN, GERD, and lumbar radiculopathy. Patient transferred to Oxford Rehab for continued medical optimization and ongoing therapy services.
Nursing Interventions:
Medication Management – Lisinopril, Apixaban, Farxiga, Duloxetine, Buspirone
Close Monitoring of Vital Signs including daily weights
Close Monitoring of Labs including CBC, BMP, Magnesium
COVID Infection – isolation precautions maintained, symptoms improved
Cardiology Interventions:
Patient was followed by our Cardiologist, Dr. Frank Ammaturo. Routine EKG completed in-house which demonstrated atrial fibrillation with rate of 90 bpm. Patient currently rate controlled, plan to continue Eliquis. Congestive heart failure is currently compensated, plan to continue Farxiga. HTN well controlled on current regimen.
Therapy Interventions:
Prior to admission she required assistance for mobility and self-care. An individualized therapy plan was developed including physical and occupational therapy. At discharge, she was Independent for bed mobility and transfers. She was able to ambulate community distances with RW at Mod I level. She also regained her independence with her activities of daily living including set-up assistance for bathing, supervision for toileting and contact guard assistance for lower body dressing.
After a short stay at Oxford Rehab, the patient was discharged safely home to her independent living community. She will continue to be followed by her Cardiologist, Dr. Toni Anne A. De Venecia in the community.
Heart Failure
Case Study
88-year-old female admitted to Oxford Rehabilitation and Healthcare Center from St. Mary Medical Center, where she initially presented with shortness of breath, productive cough, and fatigue. Patient found to be in Afib with RVR and chest Xray showed right lower lobe consolidation and pleural fluid. Cardiology and Pulmonary consulted. Pleural effusion likely secondary to diastolic heart failure. Patient s/p thoracentesis and PleurX catheter placement. Patient maintained on 2L o2 via NC. Patient s/p heparin gtt which was transitioned to Eliquis prior to d/c. Past medical history significant for Afib, COPD, HTN, HLD and Guillain Barre Syndrome. Patient transferred to Oxford Rehab for continued medical optimization.
Nursing Interventions:
Wound Management – left heel: unstageable wound, right heel: stage 3, daily dressing changes, Prevalon boots to b/l feet while in bed, left heel offloading shoe when OOB
PleurX Catheter Management – drain 3 times per week and PRN
Ensure Adequate Nutrition – tolerating regular diet with Ensure Plus daily
Cardiology Interventions:
Patient was followed by our Cardiologist, Dr. Frank Ammaturo. Afib – currently rate controlled, continue Cardizem, Metoprolol and Eliquis. CHF – continue Furosemide. HTN- well controlled
on current regimen. Pleural effusion s/p thoracentesis and PleurX catheter placement.
Pulmonology Interventions:
Patient was followed by our in-house Respiratory Therapist and Pulmonologist, Dr. Bruce Dershaw for history of recurrent pneumonia and recurrent pleural effusions along with COPD. PleurX catheter remained in place. Patient remained stable on 2L oxygen via NC and Breo Ellipta 1 puff daily.
After a short stay at Oxford Rehab, the patient was discharged safely home with support from family and St. Mary Home Care. She will continue to be followed by her PCP, Dr. Anthony Brunozzi, Cardiologist, Dr. Richard Hyman, and Pulmonologist, Dr. Mitchell Jacobs in the community.
